Weintraub: Blacks in California are forgotten minority

Blacks in California are more likely to get cancer and, once diagnosed, far more likely to die from it than other ethnic groups.

As California's Latino and Asian populations expand and whites become just another ingredient in the state's increasingly complex ethnic stew, African-Americans are at risk of becoming California's forgotten, and overlooked, minority.

And as much as we would like to live in a color-blind society, the truth remains that there are stubborn differences in the lives – and deaths – of Californians when viewed through the lens of race and ethnicity.

Consider cancer.

Blacks in California are more likely to get cancer and, once diagnosed, far more likely to die from it than other ethnic groups.

No one knows exactly why. There are many suspected causes, from genetics to environment, social conditions, behavior, culture and access to high-quality health care. The answer might be a combination of all of the above, and more.

I moderated a panel discussion in Los Angeles earlier this month in which three experts – and the audience – explored the reasons for this disparity and possible solutions. It's a difficult problem, and the group, of course, didn't solve it. But the highlights of the discussion, hosted by Zocalo Public Square, are worth recounting here.

First some background.

In California, 413 people out of every 100,000 were diagnosed with cancer in 2009, and 158 out of every 100,000 Californians died from the disease that year. But there were sharp differences among people of different ethnic groups.

Among whites, 454 out of every 100,000 were diagnosed and another 169 died. The incidence among blacks was not much higher, 460 out of every 100,000. But the mortality rate was far worse: 221 out of every 100,000.

Those numbers might suggest that this is just another reflection of the widely known disparities among whites and blacks in income, living conditions and access to health care.

But the picture gets less clear when you include the other major ethnic groups in the mix. Among Latinos, the incidence of new cases of cancer was 322 out of every 100,000, and the mortality rate was 131. That was less, in both cases, than the rates among whites. And among Asians/Pacific Islanders, the numbers were even lower: 300 and 116.

That means a black person in California is almost twice as likely to die of cancer than a Latino or Asian American.

Some would like to attribute these differences to behavior. Blacks are more likely than other ethnic groups to smoke and drink and be obese, all of which put people more at risk for cancer. But these traits are also linked to income and education, and blacks tend to be poorer and less well educated than other ethnic groups. History says that changes in behavior that produce better health have to be preceded by changes in the underlying conditions that are most associated with those unhealthy behaviors. If blacks were better educated and earned more, in other words, they would almost certainly be healthier.

But another problem is that, even after African-Americans are diagnosed with cancer, they usually die at a greater rate than other Californians. One reason for this may be that they lack access to high-quality care. Some suspect that physicians prescribe less than the most advanced treatment for low-income people generally, and that often includes blacks. Others – including some African-American physicians – point to deep mistrust of the medical profession among blacks, a sense of futility about their condition and, sometimes, cultural beliefs about the dangers of surgical treatment for cancer.

Blacks have also been underrepresented in clinical trials on new cancer drugs and procedures, robbing clinicians of valuable information about how best to treat African-Americans. For years this disparity was attributed to a reaction to the infamous Tuskegee experiments, in which researchers for the US Public Health Service allowed syphilis in African-American men to go untreated for years as they studied the disease's progression. But Dr. Mignonne Guy, a research associate at the Mayo Clinic Arizona and an assistant research scientist at the University of Arizona, says the problem today is that doctors don't ask their black patients to participate in clinical trials, perhaps out of guilt over Tuskegee or under the erroneous assumption that their patients will decline.

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